The literature of cerebral palsy is voluminous. The instant invention is directed to certain specific problems arising out of certain manifestations of certain forms of cerebral palsy.
The latter is a condition primarily centered around paralysis, incoordination or weakness of the muscular system due to pathology of the motor control centers of the brain. Typically, it is a term covering motor disabilities due to nonprogressive brain pathology typically occurring in early life. With respect to causation, broad definitions speak of prenatal, natal and postnatal pathological processes having deleterious effects on the pyramidal, extra-pyramidal or cerebellar systems. With respect to a classification of types, approaches involve (a) pathology, (b) the presenting clinical syndromes and (c) the regions of the body affected.
Five types are generally recognized in cerebral palsy, with varying degrees and types of motor involvement: spastic, dyskinetic (including athethoid), ataxic, mixed and flaccid. The American Academy of Cerebral Palsy recognizes seven types: spastic, athetotic (tension, non-tension, dystonia and tremor athetosis), rigidity, ataxic, tremor, atonic and mixed. Speaking descriptively, the spastic type, comprising some 65% of the cerebral palsied, typically involves stiffness of musculature, with motions of the extremities made slowly and with great effort. Thus, when the afflicted person attempts to bend the joints, the opposing muscles contract, blocking the patient's efforts. In the athetoid type, typically comprising 30% of the afflicted, the individual moves his body or parts of his body even when he does not wish to. The body and extremities may be in constant motion. The individual may have difficulty in controlling and directing his movements. Phelps recognizes nine types of athetoids. These include rotary, dystonic, tremor-like, shudder-like, flail, non-tension, hemi-athetoid and emotional release athetosis.
In a classification based on neuromuscular characteristics, five types were distinguished, including spasticity, athetosis, tremor, rigidity and ataxia. With respect to the tremor syndrome, the muscles are typically normal in tone with no abnormal reflexes. The distinguishing characteristic is repetitive and rhythmic involuntary contractions of the flexor and extensor muscles. In the intentional sub-class, such are not present at rest and appear with voluntary or intended movement. In the non-intentional sub-class, such are present at rest and also continue with intended movement. Typically, these involuntary movements are fine and rhythmic, not gross and variable like the athetoid type. In the lower extremities, such tremors tend to throw the individual off balance. In the upper extremities, they interfere with hand skills and often may prevent development of writing skills and the like.
In therapy of cerebral palsy conditions, rests, body braces, special chairs and tables, corsets and other devices may be used to control those motions which use up much of the energy of cerebral palsied individuals. Motion training may also use such devices.
With respect to the philosophy of bracing and special equipment in treatment of cerebral palsy, the need arises from the disturbances of the neuromuscular function. There are differences of opinion with respect to the value of bracing and other special equipment in treatment. Some physicians value and some contraindicate. The purpose of use of such special equipment is to provide needed support, aid in control of involuntary movements, prevent or correct deformities and combinations of these.
In the literature, it is recognized that bracing and special equipment applied to the upper extremities is much less common. It is typically not needed for erect posture of the individual. To correct and prevent deformities of the upper extremities is very difficult. Many physicians consider it impractical to brace the shoulder and elbow joints. In such use, bracing of spastic hands is the most common type in order to counteract flexion deformities.
The previous ideas have been abstracted from the works of Allen, R. M. et al "Psychological Evaluation of the Cerebral Palsied Person" and McDonald, E. T. et al "Cerebral Palsy".
In Keats, Sidney "Cerebral Palsy", 1965, C. C. Thomas, Springfield, Illinois, under Chapter V Modalities of Treatment, Subsection 6 Bracing, Page 236, there is first discussed foot, leg and back braces, particularly directed toward treatment of athetoid syndromes. Thereafter occurs a discussion of problems and efforts to control involuntary arm movement, such being devised according to the individual problem. Mentioned are spoon splints to prevent wrist flexion (which may extend to the forearm), hand sandwich braces to aid in controlling wrist and hand extension and forearm splint braces which may go above the elbow joint to maintain full or mid-supinated forearm position. Such may permit flexion and extension at the elbow joint with the forearm and hand in position of mid-supination. It also may have a bar to prevent hand rotation through the wrist.
In Cruikshank, William N. (editor) "Cerebral Palsy, Its Individual And Community Problems", 1966, Syracuse University Press, Part C, Therapy and Education, Section VIII, Physical Therapy (Ester E. Snell), bracing is discussed at page 412 et seq. Such is discussed for support, the correction of deformities and control of extra motion. Materials are given typically as steel, aluminum and plastic. Parts mentioned are uprights, crossbands, joints, stops, cuffs, pelvic bands, gluteal pads, knee caps and knee pads. In joint classification, there are mentioned simple, box, ball bearing and spring joints.
Throughout these works, and in many others related, there runs the theme of non-intellectually impaired and often superiorly motivated individuals who are yet incapacitated to a greater or lesser degree (often greater) by their damaged motor nervous systems. Additionally, the frustration of inability to accurately and, with control, perform known, projected and willed acts for such people need not be described. It is this problem of furnishing specific means by which these physically handicapped individuals may capture or recapture neuromuscular function permitting them to do fine, controlled, willed work towards which this invention and application are directed. The purpose is to provide mechanical means by which the gross and fine action and function of the entire arm and hand complex may be stabilized and controlled, despite the presence of the previously incapacitating and disabling tremors. With this recovery or capturing of these crucial actions and functions, the afflicted individual is able to grasp an aspect of himself previously denied of the highest importance. Additionally, therapy of these conditions is enabled to enter new realms previously denied it.